RG: _______________

DATA: ____/____/____

FICHA DE ATENDIMENTO CLÍNICO DE PEQUENOS ANIMAIS

DADOS DO RESPONSÁVEL
Nome
CPF
Endereço
Cidade UF
Telefone fixo ( ) Celular ( )
Celular ( )
IDENTIFICAÇÃO DO ANIMAL
Nome Espécie Raça Sexo
Idade Peso

Pelagem Procedência

ANAMNESE GERAL
Queixa principal (evolução do quadro, tratamentos, resultados):
__________________________________________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
Histórico médico pregresso:
________________________________________________________________________
Alimentação:
_____________________________________________________________________________
Contactantes:_____________________Ambiente em que vive:
_____________________________________
Vacinação:
___________________________________________________________________________________
__
Vermifugação:
__________________________________________________________________________________
ANAMNESE ESPECIAL
Sistema respiratório (secreção, tosse, espirro, cianose, dispnéia, ruído na
respiração etc):_______________________
___________________________________________________________________________________
____________
Sistema cardiovascular (intolerância a exercícios, cansaço, síncope, cianose, tosse
etc): _______________________
___________________________________________________________________________________
____________
Sistema digestório (apetite, vômito, diarréia):
_________________________________________________________
___________________________________________________________________________________
____________
Sistema urinário (ingestão de água, aspecto, volume e frequência da urina, tenesmo
vesical, disúria): _____________
___________________________________________________________________________________
____________
Sistema reprodutor: (secreção, cio, anticoncepcional, prenhez, número de filhotes,
mamas, alteração de
comportamento):
________________________________________________________________________________
___________________________________________________________________________________
____________
Sistema locomotor (claudicação, trauma, aumento de volume, marcha, impotência de
membro, frequência e tipo de
exercícios):
___________________________________________________________________________________
__
___________________________________________________________________________________
____________
Sistema neurológico (convulsão, síncopes, déficits neurológicos, deambulação,
audição, olfato, propriocepção, manias,
deglutição, alteração latido/miado):
__________________________________________________________

___________________________________________________________________________________
____________
Pele e anexos (higiene, secreção, alopecia, prurido, lesões, descamação, parasitas,
orelha): ____________________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
Olhos (secreção, olho vermelho, olho esbranquiçado, déficit visual, blefaroespasmo,
fotofobia, primeiro olho
afetado):__________________________________________________________________________
_____________
___________________________________________________________________________________
____________
EXAME FÍSICO
Postura Nível de consciência
Escore Corporal

TR: °C FR: mpm FC: bpm TPC: seg

Pulso: ppm Hidratação
Linfonodos Submand. Linf. Pré-escapulares Linf. Poplíteos
Linf. Inguinais:

Mucosa ocular Mucosa oral Mucosa

peniana/vulvar Mucosa anal
EXAME FÍSICO ESPECÍFICO
Sistema respiratório:
____________________________________________________________________________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
Sistema cardiovascular:
___________________________________________________________________________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
Sistema digestório:
_______________________________________________________________________________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
Sistema genito-urinário:
___________________________________________________________________________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
Sistema locomotor:
_______________________________________________________________________________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
Sistema neurológico:
_____________________________________________________________________________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
Pele e anexos:
___________________________________________________________________________________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
Olhos:
___________________________________________________________________________________
______
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
SUSPEITA(S) CLÍNICA(S)
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
___________
EXAME(S) COMPLEMENTAR(ES)
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
_____
PROGNÓSTICO
___________________________________________________________________________________
____________
DIAGNÓSTICO
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
TRATAMENTO
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
_____
Plantonista(s)
discente(s):_______________________________________________________________________
___
Médico(s) Veterinário(s) Responsável(is):
____________________________________________________________